Vision can be saved if detected early

A most common primary intraocular (inside the eyes) malignancy of childhood arises from primitive retinal cells of the eye. About 90% cases are diagnosed less than 3 years of age.

A common presentation is white pupillary reflex, some with squint and some with inflammation of the eye. In our country, most of the patients present with advance stage when the tumor extends externally.

In advance stage though the chance of saving eye is less but when other eye is examined and if a small lesion is detected, can be treated by focal therapy (Photocoagulation with Laser). Early detected is very important in that respect.

When treating retinoblastoma, it is first and foremost important to understand that it is a malignancy. When the disease is contained within the eye, survival rates exceed 95% in the western world.

However with extra ocular spread survival rates decreases to under 50%. Therefore, in deciding on a treatment strategy, the first goal must be preservation of life then preservation of eye and finally preservation of vision.

The modern management of intraocular retinoblastoma currently incorporates a combination of different treatment modalities including chemotherapy, photocoagulation with Laser, cryotherapy, radiation therapy and surgery like enucleation (removal of globe).

Metastatic disease is managed with intensive chemotherapy, radiation and bone marrow transplantation. Among all of this treatment options — the best, cheap and less hazardous option is photo-coagulation with Diode Laser if tumor is detected in early stage with a very small lesion. If laser is applied, eye can be saved, even useful vision can be preserved.

The treatment of children with retinoblastoma requires a team approach including an ocular oncologist, pediatric ophthalmologist, pediatric oncologist and radiation oncologist.

The chemo, radiation therapies are very expensive. Comparing all modalities, the photocoagulation therapy with Diode Laser is cheaper. This facility is available at the government set-up in Sylhet MAG Osmani Medical College Hospital. The facility is available on courtesy of WHO. Expert manpower is available there and moreover the service is offered at free of cost.

The facility of laser photocoagulation can save valuable life of a child and also rescue a family from a danger point. Children with intraocular retinoblastoma who have access to modern medical care have a very good prognosis for survival. The Sylhet MAG Osmani Medical College Hospital is ready to provide that service to the needy subjects.

Dr Khair Ahmed Choudhury
SourceL The Daily Star, June 20, 2009